母体HBV传染性与宫内感染的探讨

The relation between maternal HBV infectivity and intrauterine infection

目的 探讨母体HBV传染性与宫内感染的关系。方法 于 1999年 12月～ 2 0 0 2年 6月 ,将我院HBsAg阳性孕妇 12 2例 ,分为 3组 :HBIG组 4 9例 ;拉米夫定组 4 5例 ;对照组 2 8例。HBIG组孕妇自孕 2 8w起肌内注射HBIG 2 0 0U ,每4w一次至分娩 ;拉米夫定组自孕 2 8w始每日口服拉米夫定 10 0mg直至分娩后 4w ;对照组未予用药。三组孕妇均于孕 2 8w用药前及分娩前行血乙肝两对半及HBVDNA定量检测 ,新生儿出生后 2 4h内予HBIG 10 0U注射 ,并予HBVac 0 ,1,6方案接种 ,新生儿出生后 2 4h内免疫接种前采静脉血检测血乙肝两对半及HBVDNA定量。结果 孕 2 8w时孕妇不同的HBVDNA水平其宫内感染率差异无显著性 (P >0 .1) ;而胎儿宫内感染率随着孕妇分娩前血清HBVDNA含量的增加呈增高趋势 (P<0 .0 1)。结论 宫内感染的发生率与孕妇孕期HBV传染性相关 ,孕期高病毒血症 (即HBVDNA≥ 10 8copies/ml)与宫内感染显著相关。

Objective: In order to know the relation between maternal infectivity and intrauterine Infection. Method: From December 1999 to June 2002.122 pregnant women with positive HBsAg and their newborns were randomly divided into HBIG group( 49 cases), lamivudine group(45 cases)and control group(28 cases). Each subject in the HBIG group received an injection of 200 IU of HBIG intramuscularly monthly from 28th week of gestation to delivery, and lamivudine of 100mg was administered orally to pregnant mothers from week 28 of gestation to 4 weeks post delivery ; while in the control group no treatment was given. Blood specimens of mothers were tested for HBsAg, HBeAg, HBsAb, HBeAb and HBcAb,HBV DNA in all the subjects at the 28th week of gestation before treatment and before delivery. Newborn infants within 24 hours of birth receive 10ug of recombinant hepatitis B vaccine and 100IU of HBIG intramuscularly, followed by 10ug of vaccine at 1 months and 6 months of age. And the blood specimens for the infants were tested HBsAg, HBeAg, HBsAb, HBeAb and HbcAb, HBV DNA before inoculation. Results: The rate of intrauterine infection of the infants before interruption ( P >0.1), while the rate of intrauterine infection in HBV DNA levels after interruptive shows the rising trend in every group( P <0.01).Conclusions The rate of intrauterine infection is relative to maternal HBV infectivity in pregnancy, furthermore the severe viremia (namely HBV DNA≥10 8copies/ml) correlate with HBV intrauterine infection significantly.